It’s been 48 years since the Roe v. Wade decision made abortion legal in this country. Justice Ruth Bader Ginsburg (RBG) was a huge advocate for women, but “she was not that fond of Roe v. Wade as a decision,” because she believed the landmark ruling was too sweeping and vulnerable to attacks, according to Professor Mary Hartnett, who co-authored a biography of RBG. RBG, who passed away on September 18, 2020, was the focus of our pro-choice signature ad this year. RBG was right! Legal abortion has been under attack since it was legalized in 1973, and those attacks have ramped up in North Carolina since 2011.
Abortion is a pretty commonly used procedure. About 1 in 4 (24% in 2014) American women will have an abortion by age 45, according to the Guttmacher Institute, a leading sexual and reproductive health research and policy organization. Fifty-nine percent of women who have abortions have already given birth, also Guttmacher.
Abortion is a safe procedure. Fewer than one person dies in every 100,000 legal abortions carried out by a professional, according to the CDC’s abortion surveillance data. For example, the data shows 2 total deaths across the whole country in 2017. 8 in 2016. 3 in 2015. 4 in 2012. By comparison, 17.3 women died per 100,000 live births in 2017, per the CDC’s most recent pregnancy mortality data. That makes childbirth a lot more deadly than abortion.
Pregnancy is a medical condition, and it can be a very dangerous one. Pregnant women risk diseases like diabetes, hypertension, heart failure, seizures and more.
Being pregnant is even more dangerous if you’re a Black or Native American woman. Black women are three times more likely to die from pregnancy-related causes than white women (41.7% vs. 13.4%), according to the Centers for Disease Control and Prevention. Non Hispanic American Indian or Alaska Native women are more than twice as likely to die from pregnancy related causes than white women (28.3% vs. 13.4%). Experts say the reasons behind the racial disparities are many and complex. Lack of access and poor quality of care are leading factors, particularly among women at lower socioeconomic levels. However, affluent superstars like Beyoncé and Serena Williams both experienced life-threatening complications in their pregnancies in 2017. Williams experienced a pulmonary embolism a day after giving birth, recognized the symptoms and her concerns were still initially dismissed! A division of the National Academy of Sciences published a report exploring implicit bias and structural racism affecting how women are treated by health care professionals, called “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.”
Pregnancy greatly impacts women’s lives in other ways. As Sarah Weddington argued in Roe v Wade, “A pregnancy to a woman is perhaps one of the most determinative aspects of her life. It disrupts her body. It disrupts her education. It disrupts her employment. And it often disrupts her entire family life.”
Change in Abortion Access Since 2010 Elections
Women have lost a lot of ground since 2011, following 2010 elections, especially in Southern states and in the Midwest. Take North Carolina for example.
According to Guttmacher, in 2000 and 2010, NC leaned hostile to abortion. Through 2010, NC had some abortion restrictions or interference, like a state fund for abortion that eventually couldn’t be accessed, and a parental consent law that passed in the 1990s. But by 2020, NC became hostile to abortion rights.
Republicans took over the NC House and Senate in 2011. Gov. Bev Purdue was governor at that time. She was somewhat moderate, but the bills coming from the NC legislature were so extreme that she vetoed FIFTEEN of them in 2011!! (Note: In 2011, vetoing 15 bills was vetoing five more than had been issued combined in the 14 years since governors first got the power to reject bills, according to the Greensboro News and Record.) The Republicans put all of their new abortion restrictions into an omnibus anti-abortion bill, ironically called the “Woman’s Right to Know Act”, WRTK, which required women considering abortion to listen to anti-abortion rhetoric provided by politicians, required an invasive internal vaginal ultrasound “at least 4 hours” before an abortion, and added a requirement to wait 24 hours “before making a decision” which meant waiting at least 24 hours before having an abortion after going to the clinic. Although Perdue vetoed the bill, the legislature passed it by overriding her veto. WRTK became law on July 28, 2011.
More restrictions were added in the next long session, which was 2 years later. Many of us remember dramatic events of 2013 to try to stop or ameliorate bad anti-abortion legislation from the Amend Woman’s Right To Know bill.
In March 2013, there was a “Walk In Her Shoes” protest at Halifax Mall. Planned Parenthood, NC NOW and Naral Pro-Choice NC all were cosponsors. Two of the speakers at the Roe 2021 event were there – Tara Romano and Gailya Paliga – as well as many pro-choice legislators. (Read more about the event with NC Policy Watch, at “Reproductive Freedom Advocates Rally Today,” 3/20/2013.)
Later in 2013,there was the travesty of the Motorcycle/Vagina Bill. The bill passed the Senate as a standalone bill, and pro-choice advocates were watching for it to go to the House on Jun 27, so they could be there and get other advocates to the gallery, etc. Senators decided to hide it, so they took a motorcycle helmet bill that had been languishing and put the anti-abortion changes in there. It was finally noticed, and pro-choice advocates were incensed! Many protesters wore pink, some wore motorcycle helmets and a group of five women were prominent in the House Gallery wearing T-shirts spelling out “S H A M E.” (See the picture with SHAME at the beginning of this article.)
The motorcycle/vagina bill of 2013, SB353, placed new requirements on women’s health clinics that could make it difficult for many of them to stay open, and would allow the state’s health department to create temporary rules for North Carolina’s abortion clinics as it saw fit. These laws with restrictions targetting abortion providers are known as TRAP laws. The bill also prohibits government-administered insurance plans (including the Affordable Care Act) to pay for abortions and would require a doctor to be present when a patient is administered abortion-inducing drugs.
Looking more closely at the part of the motorcycle/vagina bill, it did 3 main things to block telemedicine abortion. 1. It banned the use of telemedicine to provide abortion care because it requires a physician be physically present during a medication abortion when the first medication is administered. 2) It requires the physician (not staff) to prescribe the pills and 3) dispense the pills. This means women can’t get these pills from their local pharmacies or through the mail. This is already a huge burden for the 91% of NC women who live in counties without abortion providers, with travel expenses, possible missed work, possible childcare complications. Also consider the extra burden during the pandemic, when travel and contact add danger from the virus. The wording of SB353 is “The physician prescribing, dispensing, or otherwise providing any drug or chemical for the purpose of inducing an abortion shall be physically present in the same room as the patient when the first drug or chemical is administered to the patient. ”
There was even a Moral Monday protest which followed the passing of the infamous bill, focusing on women’s rights and leadership. This one ended up being one of the largest turn-outs the protest event has seen, and ended in hundreds of arrests.
Organizations sued to stop WRTK under the case of Stuart v. Camnitz. A federal court blocked enforcement of the forced ultrasound provision of this law in December 2014. The informed consent provisions, however, are in effect.
There was another iteration of the so-called Women’s Right To Know bill in 2015. Part of that extended the waiting period from 24 to 72 hours and added physician reporting requirements (physicians who provide abortion care to a woman after 16 weeks must convey numerous statistics to the Department of Health and Human Services, including an ultrasound image). Advocates did manage to change the law to accept calls starting the 72 hour count, rather than requiring in person visits which would be days apart.
In 2019, NC was one of many states where legislators proposed abortion bans. NC and Other State Abortion Bans – What Are We Looking At? By May 2019, Alabama, Arkansas, Georgia, Kentucky, Mississippi, Missouri, Ohio, and Utah all had passed abortion ban bills. People around NC protested the abortion bans in May. By the end of 2019, Guttmacher reported that conservative state legislators signed 25 new abortion bans into law, primarily in the South and Midwest.
Restrictions on Abortion NOW
In North Carolina, the following restrictions on abortion were in effect as of September 1, 2020:
- A patient must receive state-directed counseling that includes information designed to discourage the patient from having an abortion
- They added waiting periods, first a 24 hour one in 2011, then a 72 hour waiting period in 2015. However, 72 hours can be started with phone consultation, it doesn’t need to be in person.
- Health plans offered in the state’s health exchange under the Affordable Care Act can only cover abortion in cases of life endangerment, or in cases of rape or incest.
- Abortion is covered in insurance policies for public employees only in cases of life endangerment, rape or incest.
- The parent of a minor must consent before an abortion is provided. As you may know, some parents would kill their daughter if they knew the daughter was pregnant.
- Public funding is available for abortion only in cases of life endangerment, rape or incest. (No public funding is available anymore, the state abortion fund is definitely history)
- There was an ultrasound requirement (at least 4 hours before abortion), but that was removed in Stuart v. Camnitz in Dec 2014.
- An abortion may be performed at or after viability only in cases of life endangerment or severely compromised health.
- The state requires abortion clinics to meet unnecessary and burdensome standards related to their physical plant, equipment and staffing. (TRAP laws)
- The state prohibits abortions performed for the purpose of sex selection. (As if we did that)
- The use of telemedicine to administer medication abortion is prohibited in NC, and has been since 2013.[ S.B. 353, Gen. Assemb., 2013 Sess] With the 2019-2020 Covid-19 epidemic, there has been increased focus by researchers, abortion rights activists and public health experts on the use of telemedicine for the provision of medication abortion nationwide.
The last point relates to the advantages that telemedicine abortion bring, which Dr. Carrie Baker has been covering in Ms. Magazine.
Crisis Pregnancy Centers Far Outnumber Abortion Clinics
Last point – Abortion Clinics vs. fake clinics, also known as Crisis Pregnancy Centers, CPCs. There are many CPCs, and few abortion clinics available, and the CPCs often get women in posing as abortion clinics.
There were 26 facilities providing abortion in North Carolina in 2017, and 14 of those were clinics. In 2014, there were 37 abortion providing facilities, of which 16 were stand-alone abortion clinics. The clinics are limited to 9% of the 100 counties. That means 91% of North Carolina counties had no abortion clinics in 2017, according to Guttmacher. The clinics are in urban areas, so women in rural areas have to travel to get to a clinic, and some have to travel for hours. In 2021, NC has 15 abortion clinics, of which six are Planned Parenthood clinics.
It is shocking to realize that there are more than 110 CPCs in North Carolina. Still, North Carolina is better off than many states in the South and Midwest. Missouri has only one remaining clinic, and is doing few if any abortions in 2021.
Taxpayers Are Subsidizing CPC Clinics And Organizations
To make matters worse, the North Carolina General Assembly is directing taxpayer money to anti-abortion organizations and clinics. In 2013, the NCGA allocated $250K in the budget to support their services. That number has gone up each budget cycle, to $1.55 million annually in the 2018 budget. They allocated $2.6 million in 2019, but that part of the budget hasn’t gone through.
North Carolina is definitely hostile to abortion now, as shown by the many restrictions added since 2011, the limited number of abortion clinics, the limited areas which have clinics, and legislature funneling taxpayer money to anti-abortion organizations and individual CPCs. All this despite how safe abortion is. We were hoping for more change in the legislature and council of state positions in the 2020 elections, but fell short. We look toward a more pro-choice future in North Carolina
- “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” 2003, https://pubmed.ncbi.nlm.nih.gov/25032386/
- “Number of deaths resulting from abortions in the U.S. 1973-2017,” Dec 2, 2020, https://www.statista.com/statistics/658555/number-of-abortion-deaths-us/
- “UNDUE BURDENS: A HISTORY OF NORTH CAROLINA ABORTION RESTRICTIONS,” https://www.acluofnorthcarolina.org/sites/default/files/field_documents/aclu-nc_undue_burdens_nc_abortion_restrictions_report_forprint.pdf
- “Perdue vetoes bill requiring waiting period for abortions,” 6/27/2011, http://pulse.ncpolicywatch.org/2011/06/27/perdue-vetoes-bill-requiring-waiting-period-for-abortions/
- “NC Gov. Bev Perdue Vetoes Abortion Restricting Bill,” 6/28/2011, https://talkingpointsmemo.com/dc/nc-gov-bev-perdue-vetoes-abortion-restricting-bill
- “North Carolina Woman’s Right to Know Act (HB 854),” Rewire News Group, 2011, https://rewirenewsgroup.com/legislative-tracker/law/north-carolina-womans-right-to-know-act-hb-854/
- “Stuart v. Camnitz,” 2011, Rewire News Group, https://rewirenewsgroup.com/legislative-tracker/legal-case/stuart-v-camnitz/
- “Law on Ultrasounds Reignites Abortion Battle in North Carolina”, 1/10/16, New York Times, https://www.nytimes.com/2016/01/11/us/law-on-ultrasounds-reignites-abortion-battle-in-north-carolina.html
- “U.S. Supreme Court steps into the abortion TRAP,” 3/2/2016, http://www.ncpolicywatch.com/2016/03/02/u-s-supreme-court-steps-into-the-abortion-trap/
- “Abortion Incidence and Service Availability in the United States,” September 2019, https://www.guttmacher.org/report/abortion-incidence-service-availability-us-2017
- “Why are black women at such high risk of dying from pregnancy complications?” 2/20/19, https://www.heart.org/en/news/2019/02/20/why-are-black-women-at-such-high-risk-of-dying-from-pregnancy-complications
- “Distance Traveled to Obtain Clinical Abortion Care in the United States and Reasons for Clinic Choice,” 12/10/19, https://www.liebertpub.com/doi/10.1089/jwh.2018.7496
- “$1.55 Million in Taxpayer Money Going to CPCs in NC Budget,” 5/31/2018, https://northcarolinanow.wordpress.com/2018/05/31/1-55-million-in-taxpayer-money-going-to-cpcs-in-nc-budget/
- “Over $2.6 Million of 2019 State Budget to CPCs,” 7/25/2019, https://northcarolinanow.wordpress.com/2019/07/25/2-6-million-of-2019-state-budget-to-cpcs/
- “Abortion by Telemedicine: A Growing Option as Access to Clinics Wanes,”4/28/20, The New York Times, https://www.nytimes.com/2020/04/28/health/telabortion-abortion-telemedicine.html
- “Planned Parenthood in Missouri disputes report state no longer performs abortions, but number of procedures fell due to new regulations,” 1/20/21, Chicago Tribune, https://www.chicagotribune.com/midwest/ct-missouri-abortions-20210120-36ytfsh37ndcvpt5yjnzan5glm-story.html
- Guttmacher : Induced Abortion in the United States, https://www.guttmacher.org/fact-sheet/induced-abortion-united-states
- “Pregnancy Mortality Surveillance System,” https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm
- “Pregnancy-Related Deaths,” https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm
- “North Carolina Women’s Right to Know Act,” https://en.wikipedia.org/wiki/North_Carolina_Women%27s_Right_to_Know_Act
- “Fake Women’s Health Centers,” https://prochoicenc.org/fake-womens-health-centers/